The role of hemoglobin A1c testing in undiagnosed diabetes and myocardial infarction in emergency and intensive care settings
Statement of the Problem: The disease of diabetes is insidious. Its complications can be devastating and, if left untreated, often leads to early mortality. With the effects of diabetes being so extensive within body systems, complications like myocardial infarction are all too common. To complicate the matter further, a large portion of the population of diabetics is undiagnosed. Having no knowledge of this disease process allows the disease to progress unfettered for an indeterminate amount of time. If diabetic status is unknown, an increased risk of mortality from MI exists. Systematic Hgb A1C testing for myocardial infarction patients may provide prognostic data for undiagnosed diabetics and increase our ability, as providers, to develop treatment plans to address the increased risk of mortality posed to these individuals. Methods: All MI patients admitted to ED and ICU charts were screened for hemoglobin A1C testing and diabetic care planning as evidenced in their discharge summary. Results: This project found that testing with Hgb A1C only occurred in 40% of MI patients. Of those tested, 8% were found to be new diabetics. This project also found that 16.3% of the patients tested were pre-diabetic and that this was only noted in 1.8% of these patients' discharge summaries. Conclusions: Currently, Hgb A1C testing is underutilized in MI patients. Identification of new diabetics in this population allows providers to address this diagnosis in a manner that can prevent the complications all too common to diabetics with heart disease.